社区2型糖尿病老年人跌倒恐惧的相关因素分析

Analysis of factors related to fear of falling in community-dwelling elderly patients with type 2 diabetes

目的调查跌倒恐惧对老年2型糖尿病患者临床、功能和步态的影响，并确定这一人群跌倒恐惧的预测因子。方法人选238例社区2型糖尿病患者，年龄65-89岁，根据跌倒效能国际评分（FES-I）分为2组，跌倒恐惧组（≥23分）120例；无跌倒恐惧组（〈23分）118例。收集入选患者人口统计学资料、人口测量学资料、共病个数、服药数量、身体活动情况、跌倒史、衰弱程度、认知状态、抑郁症状、空腹血糖水平及糖尿病病程。功能测试工具包括起立一行走试验、5次起坐试验及握力、步速。结果跌倒恐惧组与无跌倒恐惧组比较，衰弱的程度高，抑郁症状多，起立一行走试验、5次起坐试验成绩差。跌倒恐惧组表现出低步速、短步长，而迈步的时间和摇摆换步的时间更长。多元回归分析结果显示，老年抑郁量表（GDS-15）评分每增加1分，跌倒恐惧的可能性增加1．32倍（OR：1．32，95％CI：1.09-1．58）；起立一行走试验每增加1s，跌倒恐惧的可能性增加1.35倍（OR：1．35，95％CI：1．06-1．70）。结论社区2型糖尿病老年患者跌倒恐惧与衰弱、抑郁症状、动态平衡、功能灵活性和步态异常相关，GDS-15评分和起立行走试验可预测这一人群的跌倒恐惧。

Objective To investigate the influence of fear of falling on clinical, functional, and gait variables in elderly patients with type 2 diabetes and to identify predictive factors for fear of falling in this population. Methods A total of 238 community-dwelling older persons with type 2 diabetes （aged 65 to 89 years） were divided into two groups according to Falls Efficacy Scale-International scores. Participants with a score〈23 were assigned to the no-fear group （n= 118） and those with a score≥23 were assigned to the fear group （n= 120）. Demographics, anthropometrics, number of diseases and medications, physical activity level, history of falls, frailty level, cognition, depressive symptoms, fasting glucose level, and disease progression were collected. Timed Up and Go test （TUG） ,five times sit-to-stand test （5-STS） ,and tests for grip strength and pace were run. Results Participants in the fear group were more frail and presented more depressive symptoms and worse performance in the TUG and 5-STS tests than in the no-fear group. The fear group also showed a slower pace,a shorter step length,a longer step time,and a longer swing time. Multivariate regression analysis revealed that the likelihood of having fear of falling increased by 1.32 times （OR ： 1.32,95 CI：I. 09 -1.58） for every one point increase in the Geriatric Depression Scale （GDS-15） score and by 1.35 times （OR ： 1.35,95 %C1：1.06-1.70） for every one second increase in TUG. Conclusions The fear o{ failing in community-dwelling elderly patients with type 2 diabetes mellitus is associated with frailty,depressive symptoms, dynamic balance, functional mobility, and abnormal gait. Furthermore, both GDS-15 and TUG test can predict fear of falling in this population.